REGISTERING OF FATAL DISEASES.

601 ’be,selected by the medical oflicer to attend on this occasion. In the population of such districts as these, there "’would be enough midwifery practice, exclusive of paupers. I therefore propose that females, properly instructed; do attend the paupers, and, in case of difficulty, the medical officer should have £1for his attendance. These extra cases would not frequently occur, and the amount in fees to the parishes would be insignificant ; but to the medical man it would be the usual and common consideration. They should be paid at the time by the overseers of the parishes in which such cases occur. Although I name these extras, I would sooner include them in the annual stipend, if the per centao-e were rnisecl. The agreement would be more simplified, and more

club, byrtealecta-ub him—Mr. BedinSfield at the same time having a club open, where, of course, they would not be neglected; putting aside, I say, this sapient inference, I beg leave to observe that as one of the parish surgeons of this neighbourhood, if the observation be intended to apply tome, it is a gratuitous untruth. I have the honour to remain, Sir, your very obedient servant, C. R. BREE.

Stowmarket, July 2nd,

1837.

MEDICAL REGISTRARS.

approved. An annual stipend thus secured would, in my opinion, be mere satisfactory than the appearance of a lengthened detail of extras. I feel certain that it is to the advantage of the profession to avoid bills, in pauper practice. I do not dwell much upon the examples which I have adduced, but the mode of aplrointrrzent, and the ftxing of the remuneration, which appear to me to be principles which, if established, will at once recognize the independence and respectability of the professional men who are so engaged. Hinckley, Oct. 22, 1836.

’

STOWMARKET PENNY CLUB. To the Editon of THE LANCET. Sxtt:—In a communication from -iNIr. James Bedingfield, inserted in the last week’s LavCET, I find the following observations:—" I become every day more and more convinced ! of the injurious tendency of the penny club system. In this neighbourhood its effects have been the following;—to induce the parish surgeon to neglect his parish patients, in order to compel them to become members of his club," &c., &-c. Upon this passage, I trust that you will allow me to make a few

I

To the Editor of THE LANCET. Str.:—I shall be glad to learn from the medical parish clerks, if they think it possible to render the degradation of our profession more complete ? I say " our," because, perhaps, these would-be-gentlemen may have enough humility to admit the incompatibility of their new pursuit with the scientific and dignified discharge of their old one. The rot-ocracy of Bath nearly succeeded, about twenty years ago, in excluding medical men from their assemblies. Who would not justify the renewal of an attack, which, although then originating in a vulgar affectation of exclusiveness, would now be nothing more than a proper vindication of good society from the imputation of a degrading alloy in the persons of wretched stipendiaries without the education, pride, or bearing of gentlemen? I contmenced this, not in the Commercial Road, Litrzehouse. I conclude it in the Hampstead Road. I learn, with bitter mortification, that of every 12 candidates for the parish cterkships, 11 are medical practitioners ! There is not less justice than severity in your dignified rebuke of the Nottingham Volunteers. I pray you, spare not the parish-clerks. Your’s obediently,

A. D.

REGISTERING OF FATAL DISEASES.

To the Editor of THE LANCET. SIR :—Haviug received a circular fronl. the College of Surgeons, the object of which remarks. In the first place, I have to observe, that is the recommendation that surgeons should when a communication was made to Mr. ! render assistance to the registrars of deaths Bedingfield last Christmas, that Mr. Free- and births, by sending to them a written man and myself intended to give up our statement of the name of the disease, by connection with the medical club established which each person dying under the care of in this town and neighbourhood, Mr. Beding- a practitioner came to his death, I beg to field’s answer was, that he should still continue to support it, and attend those members who were desirous of having his advice, and he immediately issued circulars to that effect, a copy of which I enclose. In the second place, permit me to remark, that, putting aside the manifest absurdity of a medical man making a patient enter his

say, with

regret, that I cannot attend to their wishes on this subject, because the College, as the head of the profession, have in no way interested themselves in ameliorating the condition of its members, by petitioning and

remonstrating against

the

disgraceful

generally adopted in the Poor Law Unions, under the direction of the

éontract system

602

three Poor Law Commissioners. Until some plan be adopted, of universal application, and not dependant upon the whims of Boards of Guardians, I must decline rendering any assistance to the registrars, and

and no doubt this course was purThe apparentslowness of the pulse, at times, is easily accounted for by the imperfection of the mitral valves The action of the heart we have often found to be double I most strongly urge the general adoption of or triple the number of pulsations at the this plan by all medical practitioners, not- wrist. This inequality was never accounted withstanding I deeply regret the circum- for till auscultation cleared up the mystery. stance in a medico.statistical point of view. In the post-mortem report there is an obI am, Sir, your obedient servant, scurity respecting the r°ednes.s of the vessels. It does not state whether this redness was A COUNTRY SURGEON. confined to the blood vessels, or extended to July 7th, 1837. the air vessels or tubes. The case of our King is altogether one of extreme interest, aud we hope that some account will be DISEASE OF HIS LATE MAJESTY. given of the symptoms, and the effects of remedies." The following remarks on the post-mortem examination of his late Majesty William the Fourth appear in the "Dledicu-Cllirurgical Review " of July l,and have heen forwarded EDINBURGH ROYAL INFIRMARY. to us for publication in THE LANCET:"The line of demarcation between the ANEURYSM OF THE SUBCLAVIAN ARTERY TREATED BY LIGATURE Of THE ARTERIA INNOchronic and the acute-the old and the re311,NATA, BY MR. LIZARS.—DEATH, TWENTYcent—the structural and functional ajfecONE DAYS AFTER THE OPERATION.—POSTtions, in the above case, is easilydefined. MORTEM APPEARANCES. In the FORMER category, are, the pleural adIN THE LANCET of June 17th last, we inhesiotis in the left side; the tracheal and bronchial ossifications ; the enlargement of serted a report of the above operation, perthe heart; ossification of mitral and aortic formed on Alexander Duncan, on the 31st valves ; thickenings of the aortic coats ; of May previous, and detailed the progress enlargement and degeneration of structure in of the case for one week after that date. the liver; enlargemeutof spleen ; induration We are now enabled to publish a report of of pancreas ; granulation of kidney. the entire case, with all engraving of the "Among the recent, functional, and in- parts more immediately involved in the opegainimatoi-y affections, must be ranged the ration ; and in order to place the whole pericarditis, with its product adhesion by before the reader at one view, we give in eoagulable lymph; eflusion into the right this place a brief outline of that portion of cavity of the chest ; hepatization of the the report which has already appeared, lung. That this was red hepatization, commencing the additional details from the marking it as the product of recent intlam- 8th of June, referring for full particulars to mation, is clear from the general inflamma- page 445 of the present volume of this tion surrounding, and from the specific allu- Jounnal :— sion to redness of the vessels—bronchitis. Alexander Dancan, aged 30, a carter, adThus, then, there were three kinds of acute mitted May 28, 1S37. Fifteen months ago or subacute inflammation engrafted on pre- he met with a fall, and again another fall, vious organic disease, namely, pleuritis and on the elbow, eleven months since, which pericarditis, pneumonia, and bronchitis. led, six weeks ago, to the appearance of a This was a most formidable complication, small pulsating tumour, above the clavicle, and we have no doubt that the condition of indicating aneurysm of the subclavian parts was accurately ascertained, during life, artery, for which Mr. LIZARS determined and that the treatment was skilful and ap- on tying the arteria innominata. The operator having arrived at the innominata, an propriate. "That the organic changes above enume- aneurysm needle was carried round it, from rated had existed for years before the acces. the right side, upwards, towards the trasion of his Majesty’s last illness, there can chea ; the ligature was seized, and the artery be no doubt; and that the royal sufferer tied. The haemorrhage during the proceedmight have lived for years, had the inflam- ing amounted to abobt two ounces. The patient was examined two hours mation of so many different structures not supervened, there is every probability. The after the operation, and did not present any supervention of inflammation on old stand- unfavourable symptoms, excepting some ing organic diseases renders the management pain in the course of the carotid and braof the case more diflicult, but does not alter chial arteries, and at about the elbowjoint, the principles of the treatment. In such a which, towards evening, were attended by multiplicity of inflamed tissues as dissection pain, on inspiration, in the right side of here disclosed, nothing but the strictest an- the chest. The pulse was full, and varied tiphlogistic treatment could offer a hope of from 74 to 78. The pulsation iu the tumour

I

relief;

sued.